Research
We are proud to be a research-active organisation, which means we develop and host research studies which contribute to and improve emergency medical care and patient outcomes in the UK and worldwide.
As London has such a diverse population with a variety of health conditions and needs, we have a wide-ranging research portfolio to work with and can investigate a number of different topics. And not just in clinical areas; as we’re a large organisation we can also explore organisational and workforce issues too.
Take a look at some of our published research in the drop down box below, or find out about our current research projects by clicking on the boxes at the bottom of the page.
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How can I start a research project with you?
All proposed research involving London Ambulance Service staff, our patients or their data must be formally considered through our Trust Research Approval process. This application process includes a feasibility assessment of the study and consideration of whether or not the research will be of benefit to the Trust.
We welcome opportunities for collaborative research with academic, commercial and third sector organisations, as well as with other NHS Trusts.
For student research projects, we accept applications from staff who have substantive contracts with our Trust and are undertaking research as part of an educational qualification. However, we do not have the capacity to support external student’s requests for research that is below PhD level.
PhD research proposals will be considered on a case-by-case basis and may be supported if undertaken collaboratively with LAS, and if the project aligns with our research priorities and there is no overlap with our own research programme.
Please get in touch for further information:
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Completed research projects
ARREST TRIAL
We took part in the ARREST trial which will help paramedics and doctors decide the best treatment for patients who have a cardiac arrest outside of hospital. Learn more.
PARAMEDIC2
This trial, funded by the NIHR Health Technology Assessment, aimed to understand whether using adrenaline is helpful or harmful when treating someone experiencing a cardiac arrest outside of a hospital. The study ran between 2014 and 2017. PARAMEDIC-2 is officially the largest cardiac arrest drug trial in Europe, involving 8,014 patients (2,102 recruited by the LAS) and the largest randomised placebo-controlled trial examining the role of adrenaline in cardiac arrest.
Background
Adrenaline has been an integral component of advanced life support for over 50 years, but it had not previously been fully tested to see if it is beneficial for patients who have a cardiac arrest outside of hospital. This randomised controlled trial compared the clinical and cost effectiveness of adrenaline versus a saline placebo for the treatment of out-of-hospital cardiac arrest. Drugs were blinded so that paramedics were unaware of which drug they were administering. All other aspects of resuscitation practices remained unchanged.
Four other ambulance trusts also participated in the trial (South Central, North East, West Midlands and Wales). The trial was supported by the International Liaison Committee on Resuscitation, Resuscitation Council (UK), College of Paramedics and the Joint Royal College Ambulance Liaison Committee.
Results
The trial found that, after 30 days, adrenaline resulted in a slight increase in survival but much greater likelihood of severe disability.
The results were published in August 2018 in the New England Journal of Medicine. Further details can be found on the trial website.
PARAMEDIC-2 was listed in the top 100 papers for 2018 (#27) in terms of the Altmetric score.
RIGHT-2
This trial, funded by the British Heart Foundation, aimed to understand whether glyceryl trinitrate (GTN) improves outcomes for patients who experience a stroke. The study ran between 2016 and 2018.
Background
High blood pressure (BP) is common in stroke patients and generally associated with poor outcomes. This trial aimed to understand if using GTN as soon as possible after the onset of a stroke improved patients’ neurological outcome. This randomised controlled trial involved paramedics administering either GTN or placebo patches to patients within four hours of them experiencing symptoms.
Six other ambulance trusts (East Midlands, West Midlands, East of England, South West, South East Coast and Wales) also participated in the trial.
Results
The trial found that pre-hospital treatment with GTN for patients with presumed stroke does not appear to improve functional outcome.
The results were published in February 2019 in The Lancet.
PRE-HOSPITAL EMERGENCY DEPARTMENT DATA LINKING PROJECT
This mixed-methods research project, funded by the Health Foundation, aimed to determine the feasibility of and potential learning from retrospectively linking ambulance service data to Emergency Department (ED) data to create a continuous electronic record of the patient journey.
The project was run in collaboration with Swansea University, the Nuffield Trust, and Kingston University and St. George’s University of London.
Background
Historically, front line ambulance crews would take a patient to hospital and, often, would have little to no further information about the patient’s outcome during and/or following their stay in hospital. The Pre-Hospital Emergency Department Data Linking Project (PHED Data) was designed to see if linking ambulance service data to hospitals’ would lead to benefits for the patient without compromising confidentiality.Results
PHED Data showed it is possible to link ambulance data to ED data across multiple sites, which would suggest that national implementation would also be feasible using the same method.NHS England has since approved the bid to run this project nationally. The results of the project now form the Ambulance Data Set which will standardise and link data nationally, and will be rolled out across all ambulance services and emergency departments across England.
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Our published research
Here are some publications from our most recent research that either feature our staff or some of our data. Names of our staff involved in each project are highlighted in bold.
2021
Adrenaline to improve survival in out-of-hospital cardiac arrest: the PARAMEDIC2 RCT
Authors: Gavin D Perkins, Chen Ji, Felix Achana, John Jm Black, Karl Charlton, James Crawford, Adam de Paeztron, Charles Deakin, Mark Docherty, Judith Finn, Rachael Fothergill, Simon Gates, Imogen Gunson, Kyee Han, Susie Hennings, Jessica Horton, Kamran Khan, Sarah Lamb, John Long, Joshua Miller, Fionna Moore, Jerry Nolan, Lyndsey O’Shea, Stavros Petrou, Helen Pocock, Tom Quinn, Nigel Rees, Scott Regan, Andy Rosser, Charlotte Scomparin, Anne Slowther, Ranjit Lall
Journal: Health Technology Assessment
Status: Published April 2021
Read the study here.Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of hospital cardiac arrest
Authors: Kirstie L Haywood, Chen Ji, Tom Quinn, Jerry P Nolan, Charles D Deakin, Charlotte Scomparin, Ranjit Lall, Simon Gates, John Long, Scott Regan, Rachael Fothergill, Helen Pocock, Nigel Rees, Lyndsey O’Shea, Gavin D Perkins
Journal: Resuscitation
Status: Epub ahead of print January 2021
Read the study here.2020
Out-of-Hospital Cardiac Arrest in London during the COVID-19 pandemic
Authors: Rachael Fothergill, Adam Smith, Fenella Wrigley, Gavin Perkins
Journal: Resuscitation Plus
Status: Epub ahead of print December 2020
Read the study here.Sub30: Protocol for the Sub30 feasibility study of a pre-hospital Extracorporeal membrane oxygenation (ECMO) capable advanced resuscitation team at achieving blood flow within 30 min in patients with refractory out-of-hospital cardiac arrest
Authors: Ben Singer, Joshua C. Reynolds, Gareth E. Davies, Fenella Wrigley, Mark Whitbread, Mark Faulkner, Ben O’Brien, Alastair G. Proudfoot, Anthony Mathur, Thomas Evens, Jane Field, Vivienne Monk, Simon J. Finney, and , on behalf of the International ECMO Network (ECMONet)
Journal: Resuscitation Plus
Status: Epub ahead of print October 2020
Read the study here.Enhancing predictions of patient conveyance using emergency call handler free text notes for unconscious and fainting incidents reported to the London Ambulance Service
Authors: Liam Tollinton, Alexander M. Metcalf, Sumithra Velupillai
Journal: International Journal of Medical Informatics
Status: Published September 2020
Read the study here.Experience of a novel community testing programme for COVID-19 in London: Lessons learnt
Authors: Gabriel Wallis, Francesca Siracusa, Michael Blank, Helena Painter, Javier Sanchez, Kelcy Salinas, Cherifer Mamuyac, Cindy Marudamuthu, Fenella Wrigley, Tumena Corrah, Tommy Rampling, Sarah Logan, Anna Goodman, Deborah Miller, Bhanu Williams, Alastair McGregor, Victoria Parris, Gurjinder Sandhu, Laurence John, Padmasayee Papineni and Ashley Whittington
Journal: Clinical Medicine Journal
Status: Published September 2020
Read the study here.A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest – MIRACLE2
Authors: Nilesh Pareek, Peter Kordis, Nicholas Beckley-Hoelscher, Dominic Pimenta, Spela Tadel Kocjancic, Anja Jazbec, Joanne Nevett, Rachael Fothergill, Sundeep Kalra, Tim Lockie, Ajay M Shah, Jonathan Byrne, Marko Noc, Philip MacCarthy
Journal: European Heart Journal
Status: Published July 2020
Read the study here.Impact of early (≤24h) versus delayed (>24h) intervention in patients with non ST segment elevation myocardial infarction: an observational study of 20882 patients from the London Heart Attack Group
Authors: Vasileios Panoulas, Krishnaraj S. Rathod, Ajay K. Jain, Sam Firoozi, Joanne Nevett, Sundeep S. Kalra, Iqbal S. Malik, Anthony Mathur, Simon Redwood, Philip A. MacCarthy, Andrew Wragg, Daniel A. Jones, Miles C. Dalby
Journal: Cardiovascular Revascularization Medicine
Status: Epub ahead of print – June 2020
Read the study here.Identifying and overcoming barriers to Automated External Defibrillator use by GoodSAM volunteer first-responders in out-of-hospital cardiac arrest using the Theoretical Domains Framework and Behaviour Change Wheel. A qualitative study
Authors: Christopher Smith, Frances Griffiths, Rachael Fothergill, Ivo Vlaev, Gavin D Perkins
Journal: British Medical Journal Open
Status: Published March 2020
Read the study here.Risk Prediction Models for Out-of-Hospital Cardiac Arrest Outcomes in England
Authors: Chen Ji, Terry P Brown, Scott J Booth, Claire Hawkes, Jerry P Nolan, James Mapstone, Rachael Fothergill, Robert Spaight, Sarah Black, Gavin D Perkins
Journal: European Heart Journal – Quality of Care and Clinical Outcomes
Status: Published March 2020
Read the study here.The influence of time to adrenaline administration in the Paramedic 2 randomised controlled trial
Authors: Gavin D Perkins, Claire Kenna, Chen Ji, Charles D Deakin, Jerry P Nolan, Tom Quinn, Charlotte Scomparin, Rachael Fothergill, Imogen Gunson, Helen Pocock, Nigel Rees, Lyndsey O’Shea, Judith Finn, Simon Gates, Ranjit Lall
Journal: Intensive Care Medicine
Status: Published March 2020
Read the study here.2019
What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom
Authors: Helen Snooks, Ashrafunnesa Khanom, Robert Cole, Adrian Edwards, Bethan Edwards, Bridie Evans, Theresa Foster, Rachael Fothergill, Carol Gripper, Chelsey Hampton, Ann John, Robin Petterson, Alison Porter, Andrew Rosser, Jason Scott
Journal: BMC Emergency Medicine
Status: Published December 2019Paramedic attitudes and experiences of enrolling patients into the PARAMEDIC-2 adrenaline trial: a qualitative survey within the London Ambulance
Authors: Johanna Lazarus, Rajeshwari Iyer, Rachael Fothergill
Journal: British Medical Journal Open
Status: Published December 2019Protocol for the impact of paramedics in NHS primary care: application of realist approaches to improve understanding, support intelligent policy and future workforce planning
Authors: Georgette Eaton, Veronika Williams, Geoff Wong, Nia Roberts, Kamal R. Mahtani
Journal: British Paramedic Journal
Status: Published December 2019Rationale and protocol for the assessment of impact of real time continuous glucose monitoring on people presenting with severe Hypoglycaemia (AIR-CGM) study
Authors: Parizad Avari; Rozana Ramli; Monika Reddy; Nick Oliver; Rachael Fothergill
Journal: BMC Endocrine Disorders
Status: Published October 2019.Using deterministic record linkage to link ambulance and emergency department data: is it possible without patient identifiers?
Authors: Sophie Clark, Mary Halter, Alison Porter, Holly Christina Smith, Martin Brand, Rachael Fothergill, Jaqualine Lindridge, Martin McTigue, Helen Snooks
Journal: International Journal of Population Data Science
Status: Published August 2019
Read the study here.The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms: Findings from the PACA and PARAMEDIC-2 randomised controlled trials
Authors: Gavin Perkins, Claire Kenna, Chen Ji, Charles Deakin, Jerry P Nolan, Tom Quinn, Rachael Fothergill, Imogen Gunson, Helen Pocock, Nigel Rees, Karl Charlton, Judith Finn, Simon Gates, Ranjit Lall
Journal: Resuscitation
Status: Published July 2019
Read the study here.Repeated adrenaline doses and survival from an out-of-hospital cardiac arrest
Authors: Rachael Fothergill, Amber Emmerson, Rajeshwari Iyer, Johanna Lazarus, Mark Whitbread, Jerry Nolan, Charles Deakin, Gavin Perkins
Journal: Resuscitation
Status: Published May 2019
Read the study here.Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial.
Authors: The RIGHT2 investigators, and Rachael Fothergill, Neil Thompson, Johanna Lazarus, Helen Werts
Journal: The Lancet
Status: Published February 2019
Read the study here.Attitudes to cardiopulmonary resuscitation and defibrillator use: a survey of UK adults in 2017
Authors: Claire Hawkes, Terry Brown, Scott Booth, Rachael Fothergill, Niroshan Siriwardena, Sana Zakaria, Sara Askew, Julia Williams, Nigel Rees, Chen Ji, Gavin Perkins
Journal: Journal of the American Heart Association
Status: Published February 2019
Read the study here.
2018
Chapters: ‘Research and evidence-based practice’ and ‘Using clinical audit to improve patient care’.
Authors: Rachael Fothergill, Joanna Shaw
Journal: Blaber’s foundations for paramedic practice: A theoretical perspective
Status: Published November 2018Temporal and geographic patterns of stab injuries in young people: a retrospective cohort study from a UK major trauma centre
Authors: Paul Vulliamy, Mark Faulkner, Graham Kirkwood, Anita West, Breda O’Neill, Martin P Griffiths, Fionna Moore, Karim Brohi
Journal: British Medical Journal
Status: Published November 2018
Read the study here.Rationale and design of: A randomised trial of expedited transfer to a cardiac arrest center for non-ST elevation out-of-hospital cardiac arrest: The ARREST randomised controlled trial.
Authors: Tiffany Patterson, Alexander Perkins, Gavin Perkins, Tim Clayton, Richard Evans, Hanna Nguyen, Karen Wilson, Mark Whitbread, Johanna Hughes, Rachael Fothergill, Joanne Nevett, Iris Mosweu, Paul McCrone, Miles Dalby, Roby Rakhit, Philip MacCarthy, Divaka Perera, Jerry Nolan, Simon Redwood
Journal: American Heart Journal
Status: Published October 2018
Read the study here.A randomized trial of Epinephrine in out-of-hospital cardiac arrest (PARAMEDIC2)
Authors: Gavin Perkins, Chen Ji, Charles Deakin, Tom Quinn, Jerry P. Nolan, Charlotte Scomparin, Scott Regan, John Long, Anne Slowther, Helen Pocock, John Black, Fionna Moore, Rachael Fothergill, Nigel Rees, Lyndsey O’Shea, Mark Docherty, Imogen Gunson, Kyee Han, Karl Charlton, Judith Finn, Stavros Petrou, Nigel Stallard, Simon Gates, and Ranjit Lall, et al.
Journal: New England Journal of Medicine
Status: Published August 2018
Read the study here.Characteristics of neighborhoods with high incidence of out-of-hospital cardiac arrests and low bystander cardiopulmonary resuscitation rates in England.
Authors: Terry Brown, Scott Booth, Claire Hawkes, Jasmeet Soar, Julian Mark, James Mapstone, Rachael Fothergill, Sarah Black, Helen Pocock, Anna Bichmann, Imogen Gunson, Gavin Perkins
Journal: European Heart Journal
Status: Published June 2018
Read the study here.Influence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out-of-hospital cardiac arrest
Authors: Tim Edwards, Julia Williams, Michaela Cottee
Journal: Emergency Medicine Australasia
Status: Published May 2018
Read the study here.
2017
London Ambulance Service source data on choking incidence for the calendar year 2016: an observational study
Authors: Matthew Pavitt, Joanne Nevett, Laura Swanton, Matthew Hind, Michael Polkey, Malcolm Green, Nicholas Hopkinson
Journal: BMJ Open Respiratory Research
Status: Published December 2017
Read the study here.Epidemiology and outcomes from out-of-hospital cardiac arrests in England
Authors: C Hawkes, S Booth, C Ji, SJ Brace-McDonnell, A Whittington, J Mapstone, MW Cooke, CD Deakin, CP Gale, R Fothergill, JP Nolan, et al
Journal: Resuscitation
Status: Published November 2017
Read the study here.Algorithms to guide ambulance clinicians in the management of emergencies in patients with implanted rotary left ventricular assist devices
Authors: Christopher Bowles, Rachel Hards, Neil Wrightson et al. Mark Faulkner
Journal: British Medical Journal
Status: Published November 2017
Read the study here.Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group
Authors: KS Rathod, S Koganti, MB Iqbal, AK Jain, SS Kalra, Z Astroulakis, P Lim, R Rakhit, MC Dalby, T Lockie, IS Malik, CJ Knight, M Whitbread, A Mathur, S Redwood, PA MacCarthy, A Sirker, C O’Mahony, A Wragg, DA Jones
Journal: European Heart Journal Acute Cardiovascular Care
Status: Published November 2017
Read the study here.Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review
Authors: CM Smith, SN Lim Choi Keung, MO Khan, TN Arvanitis, R Fothergill, Chris Hartley-Sharpe, MH Wilson, Gavin D Perkins
Journal: European Heart Journal Qual Care Clin Outcomes
Status: Published October 2017
Read the study here.Double sequential defibrillation therapy for out-of-hospital cardiac arrests: The London experience
Authors: Amber Emmerson, Mark Whitbread, Rachael Fothergill
Journal: Resuscitation
Status: Published June 2017
Read the study here.Can pre-hospital National Early Warning Scores identify patients most at risk from subsequent deterioration?
Authors: Joanna Shaw, Rachael Fothergill, Sophie Clark, Fiona P Moore
Journal: Emergency Medicine Journal
Status: Published May 2017
Read the study here.Support and Assessment for Fall Emergency Referrals (SAFER)2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate
Authors: Helen Snooks, Rebecca Anthony, Robin Chatters, Jeremy Dale, Rachael Fothergill, Sarah Gaze et al
Journal: Health Technology Assessment
Status: Published March 2017
Read the study here.Paramedic assessment of older adults following falls including community care referral pathway: Cluster randomised trial
Authors: Helen A. Snooks, Rebecca Anthony, Robin Chatters, Jeremy Dale, Rachael Fothergill et al
Journal: Annals of Emergency Medicine
Status: Published March 2017
Read the study here.A randomised trial of expedited transfer to a cardiac arrest centre for non-ST elevation ventricular fibrillation out-of-hospital cardiac arrest: The ARREST pilot randomised trial
Authors: Tiffany Patterson, Gavin D Perkins, Jubin Joseph, et al Mark Whitbread, Rachael Fothergill, Joanne Nevett
Journal: Resuscitation
Study: Published March 2017
Read the study here. -
PARAMEDIC-3 trial
The University of Warwick is working with ambulance services in this area to study how best to give people life-saving medications if their heart suddenly stops (they have a cardiac arrest).
If your family member had a cardiac arrest and was treated by the ambulance service, they may have been included in this study.
If you would like more information about this study, please contact:
- Telephone: 024 765 72905
- Email: [email protected]
- Visit: www.warwick.ac.uk/paramedic3
This study is funded by the National Institute for Health Research (NIHR) HTA programme (NIHR131105). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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Latest research projects
CRASH-4
Intramuscular tranexamic acid for the treatment of symptomatic mild traumatic brain injury in older adults: a randomised, double-blind, placebo-controlled trial
CRASH-4 is exploring the role of intramuscular Tranexamic Acid (TXA) in older patients with mild symptomatic traumatic brain injury (TBI). Trial-trained paramedics administer the trial drug, containing either TXA or a placebo, to these patients on scene.
With increasing age, the risk of intracranial bleeding following mild TBI increases and outcomes for older patients are poorer, with more dying and fewer making a full recovery. Patients may suffer large bleeds or smaller microbleeds that are associated with the development of dementia. CRASH-4 aims to establish if TXA is a useful treatment which prevents intracranial bleeding and improves outcomes for this patient group.
PARAMEDIC-3
Pre-hospitAl Randomised trial of MEDICation route in out-of-hospital cardiac arrest
PARAMEDIC-3 is a randomised-controlled trial investigating the best way to deliver drugs to patients in cardiac arrest. Ambulance services across England and Wales are taking part, and the study aims to recruit 15,000 patients. Eligible patients will be randomised to an intravenous-first (IV) or intraosseous-first (IO) vascular access strategy.
Current evidence suggests that the earlier a patient receives cardiac arrest drugs, primarily adrenaline, the better their chances of surviving with a good neurological outcome. With 30,000 cardiac arrests in the UK each year, if adrenaline were given one minute earlier it may result in 200 extra lives saved. Earlier studies have shown that IO has a higher first-pass success rate, but no high quality data exists regarding patient outcomes. As a result, the International Liaison Committee on Resuscitation (ILCOR) has called for a randomised controlled trial to answer this question.
PROTECTeD
Exploring and Improving Resuscitation Decisions in Out of Hospital Cardiac Arrest
PROTECTeD aims to explore and improve decision-making regarding termination of resuscitation. It is comprised of five work packages, including interviews with cardiac arrest survivors and their families, London Ambulance Service clinicians and Emergency Department staff. By exploring the perspectives of these groups, this research project aims to change the way we manage termination of resuscitation – developing a consensus of evidence based, ethically grounded guidelines that optimise outcomes for patients and are sensitive to the needs of relatives and the demands on NHS services.
RAPID-MIRACLE
Developing a digital handover application for paramedics to provide a personalised approach to pre-hospital stratification for OOHCA (Out Of Hospital Cardiac Arrest)
RAPID-MIRACLE is a prospective observational study aiming to validate the MIRACLE2 score in the prehospital setting. The MIRACLE2 tool was designed by researchers at Kings College Hospital in collaboration with London Ambulance Service to predict neurological outcomes for patients in out-of-hospital cardiac arrest. The tool aims to stratify patients based on the nature of their cardiac arrest, taking account of variables like age, shockable rhythm and adrenaline administration. As blood pH is also a variable of interest, RAPID-MIRACLE will involve point-of-care blood testing. Advanced Paramedic Practitioners (Critical Care) will aim to recruit 500 patients into the study who will be followed-up to measure survival. Later, the score will be refined and integrated into a digital smartphone application that could be used on scene to predict patients outcome.
SIS
Randomised controlled trial of the clinical and cost-effectiveness of cervical spine immobilisation following blunt trauma (SIS trial)
The LAS is participating in the Spinal Immobilisation Study (SIS), a randomised controlled trial which aims to determine whether movement minimisation is non-inferior to triple immobilisation (hard collar, blocks and scoop) for trauma patients with suspected cervical spine injury.
This important study has been funded by the National Institute for Health and Care Research and will provide much-needed evidence to support our approach to managing these patients in the future. The study has been approved by an independent Research Ethics Committee.
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